Provider Demographics
NPI:1154810935
Name:CALHOUN, DEMARIO
Entity type:Individual
Prefix:
First Name:DEMARIO
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 N MAIN ST UNIT 1441
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3296
Mailing Address - Country:US
Mailing Address - Phone:214-205-5538
Mailing Address - Fax:
Practice Address - Street 1:752 N MAIN ST UNIT 1441
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3296
Practice Address - Country:US
Practice Address - Phone:214-205-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36527249347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker